What is Toothache?

Your tooth has a nerve supply and a blood supply (called the dental pulp), much like any other organ or tissue of the body. If this is irritated by trauma, decay or any other means then an inflammatory response occurs inside your tooth.

If you get an inflammatory response on your skin for example the area will become red and swollen and your skin will stretch. As your tooth cannot stretch, pressure builds up inside the tooth which causes pain.

Dental Abscess

An abscess is essentially a collection of pus (dead tissue and bacteria). If you get toothache due to inflammation inside your tooth, this inflammation eventually forces the blood supply to be cut off to the tooth and the dental pulp dies.

This dead tissue and its by products eventually leave out of the end (apex) of the tooth and form a gathering of pus beneath the tooth. This is why you may get a swelling, the tooth feels high or raised and it is sore to bite on.

Stages of Toothache

1. Something will happen to your tooth: fracture, crack, decay; often this will go unnoticed or be hidden

2. This will irritate the inside of the tooth (the dental pulp), leading to inflammation

3. This inflammation will cause pain that comes and goes and is often made worse with hot, cold or sweet things - this should be when you see the dentist as early as possible as the inflammation may be reversible.

4. If left (or even sometimes if treated) this will progress to pain, more and more often, as the inside of the tooth becomes more inflamed until constant inflammation in the tooth causes constant pain

5. At this point of constant pain, the inflammation is not reversible and therefore the tooth will require a root canal treatment or removing/extracting in order to get rid of the pain

6. This inflammation and pain will spread out of the end of the tooth and cause inflammation directly under the tooth making it even more painful to bite on.

7. If left untreated at this stage or if your dentist has been unable to disinfect the tooth fully during treatment then this will progress to form an abscess beneath the tooth which can lead to swelling and systemic infection.

8 If still left untreated then this can lead to hospitalisation, Intravenous antibiotics and as seen usually in third world countries, death.

Managing toothache at home

1. Toothache as described above is usually progressive and so early treatment is always the best option.

2. The inflammation can be managed with anti-inflammatories in the first instance (ibuprofen, nurofen etc) but the dentist will need to remove any previous fillings, decay or cracks as early as possible to

3. If left too long the inflammation will become irreversible and although it may be relieved somewhat by ibuprofen, the inflammation and therefore pain will persist until it is treated by a dentist.

4. If you have a swelling or pain caused by an abscess (usually in very filled teeth or previously root treated teeth) then antibiotics may be given to help reduce the abscess and pain but this is only temporary and your tooth will need root treating, re-root treating or extracting/removing in order to prevent reoccurence.

How the dentist assesses toothache

1. Most importantly they will take a history of your pain. This will include how long have you had it for? where is it? is is constant? what type of pain is it (e.g. throbbing, shooting etc)? does the pain spread anywhere? does anything make it better or worse? how severe is the pain out of 10?

2. They may tap on the tooth to check for inflammation underneath the tooth

3. They may put something hot or cold onto your tooth to check the extent of the inflammation in your tooth

4. They may take an x-ray for early signs of abscess or inflammation, decay beneath fillings, fractures etc.
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​5. They will use some or all this information to develop a treatment plan for you.

How the dentist treats toothache?

1. If reversible and in early stages, your dentist will remove any fillings and decay and put a sedative dressing in your tooth to help reduce inflammation before getting you back at a later date to refill the tooth, all being well.

2. If irreversible your dentist will decide with you whether to extract/remove your tooth or to carry out the initial stages of a root canal treatment in order to relieve the pain and save your tooth.

3. NOTE: sometimes no matter how much the area is numbed, the initial root treatment stage will still be painful for a few seconds while the dentist relieves the pressure in your tooth. This may be neccessary and unavoidable in order to save the tooth

4. NOTE: occasionally if you have an abscess your dentist may give you a course of antibiotics before carrying out any treatment. Alternatively your dentist may lance (pop) the abscess in order to relieve the pressure and pus in this area.